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DocuSign Envelope ID:06FA3CE5-ECA5-46AD-81OC-45C308AOCA40 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Coulter Jewell Thames PA Party/Vendor Contact Person: Jeff Williams Contact Phone: 919- <br /> - 682-0368 Party/Vendor Address: 111 West Main Street City Durham State: NC Zip: 27701 Department: DEAPR <br /> Amount: $2,3000 Purpose: Topo SurveX Budget Code(s): 61370035 880000 20028 Vendor # 54067 (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ <br /> Amendment ® Effective Date 5/23/2016 Approved by Board Yes❑No® Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> DocuSigned by, <br /> Department Director'sSignatu��61 4 SlAhu� Date: <br /> 1 CFA1D507A495... 3/24/2016 <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards, specifications,and requirements: <br /> DocuSigned"by: <br /> '�.�. <br /> Office of the Risk Management Officer QuSa r wt,�16 Date:�r6 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> DocuSigned by: <br /> Office of the Chief Financial Offic r Date: <br /> 7D4E5181ACC1409... 3�29/2016 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office of the County Attorne .16 In, K6tyfs Date: <br /> EAAMKEDM8465... 3/29/2016 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ 1Jolloydnoranae�� <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> Revised 1/16 4 <br />